Adefovir dipivoxil was recently approved for the treatment of wild-type and lamivudineresistant hepatitis B virus (HBV) infection. Tenofovir disoproxil fumarate, a congender of adefovir that is used in the treatment of HIV infected patients, has recently been shown to also be effective in patients with lamivudine-resistant HBV infection. We therefore compared the two substances in a study of 53 patients defined by high HBV DNA (>6 log 10 copies/mL) levels and genotypic evidence of lamivudine resistance. Thirty-five patients received tenofovir for 72 to 130 weeks, and 18 received adefovir for 60 to 80 weeks. Changes in HBV DNA levels were followed for the complete period of 48 weeks. Early viral kinetics were compared on matched subgroups of 5 patients each. Individually, all tenofovir-treated patients showed a strong and early suppression of HBV DNA within a few weeks whether they were coinfected with HIV or were without comorbidity. In contrast, considerable individual variations in HBV DNA decline were observed in the adefovir group. Thus at week 48, only 44% of these patients had HBV DNA levels below 10 5 copies/mL in contrast to 100% of the tenofovir-treated patients (P ‫؍‬ . T reatment of chronic hepatitis B virus (HBV) infection with the nucleoside analogue and reverse transcriptase inhibitor lamivudine has been shown to be very effective in suppressing HBV replication without major side effects. 1 In view of the long half-life of covalently closed circular HBV DNA and the variable turnover of infected hepatocytes, long-term treatment is required to achieve complete HBV elimination (i.e., hepatitis B surface antigen [HBsAg] loss). Unfortunately, the effect of this kind of treatment is often abolished by the selection of lamivudine-resistant mutants 2 followed by the reappearance of HBV DNA to baseline levels and reactivation of chronic hepatitis B.The efficacy of the acyclic nucleotide analogue adefovir dipivoxil (adefovir) in the treatment of wild-type and lamivudine-resistant HBV infection has been described, and a daily adefovir dose of 10 mg was recently approved for the treatment of chronic HBV infection. [3][4][5][6] Tenofovir disoproxil fumarate, another acyclic nucleotide analogue that is the pro-drug of tenofovir, has been approved as a novel oral agent for the treatment of human immunodeficiency virus (HIV) infection. Its effect in lamivudine drug resistance has been recently described by us as well as by other authors. [7][8][9][10][11][12][13][14] In view of the close structural relationship between these two drugs, we conducted a study in patients suffering from lamivudine drug resistance to compare their ef-

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BackgroundHIV pre-exposure prophylaxis (PrEP) has likely contributed to large decreases in HIV incidence among men who have sex with men (MSM) in several major cities. Berlin has seen a smaller decline, and affordable PrEP has been accessible through formal channels in Germany only since autumn 2017. We aimed to investigate knowledge and use of PrEP among MSM in Berlin, and factors predictive of a desire to use PrEP and history of PrEP use.MethodsMulticentre, paper-based, self-administered survey of adult MSM whose HIV status was negative or unknown at time of participation. Data were collected from 1 October 2017 to 2 April 2018.Results473 of 875 questionnaires were returned (response rate 54.1%; mean age 37.4 years, range 18–79). 90.0% of participants were aware of PrEP and, of these, 48.2% felt well informed about it. Among the 17.2% of participants reporting PrEP use, 59.3% indicated obtaining some or all of it from informal sources. 23.7% of those with no history of PrEP use reported having condomless anal intercourse (CAI) with two or more partners over the past six months. Worries about side effects, cost, not having a doctor who prescribes it, and a lack of information were the most frequently reported barriers to PrEP use. A desire to use PrEP and history of PrEP use were associated in our multivariable model with having multiple CAI partners. A history of PrEP use was associated with having a university degree, one or two parents born outside Germany, or friends living with HIV.ConclusionsWe found high awareness of PrEP among MSM in Berlin, but also a strong need for more education on its pros, cons and proper use. The frequency of informal PrEP use was also high, raising urgent individual and public health concerns. Policy makers need to consider recent calls to improve access to PrEP and PrEP education through regular health services.

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